Treating Pain: The “Candyman” Conundrum

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More articles from this author:

ER doc Brady Pregerson and Nurse Rebekah perform a raid and bust on that sketchy personality, the “Candyman.” Why does he exist? And what is he thinking?

In Part I of our Pain Management series, we looked at the challenge of gauging your patient’s pain. In this article, we examine the many consequences of taking a too-easy approach to a complex issue.

Dr. Brady: Treating pain and other symptoms such as nausea and anxiety is a core competency in many medical specialties. Sometimes it’s all we can do.

As doctors, nurses and PAs, we should take pride in easing the suffering of our patients. It’s morally superior to over-treat 100 drug-seekers than it is to withhold analgesia to a single patient who is truly suffering.

Some physicians have the philosophy that if they just assume all of their patients are telling the truth and treat them accordingly, everything will work out for the best. This is an attractive way to approach pain management and surely simplifies the job. It completely avoids the added task of being the narcotics police in addition to being the doctor, and your patients will love you. Also, you can often discharge patients more quickly this way, because instead of giving them a long explanation after telling them “No,” you can instead just say “Yes.” Perhaps this is the best approach.

Of course, there are downsides to being the “Candyman.” Will your nurses respect you for it? Will your DEA number be used to buy prescription drugs that are later sold to junior high school students for profit? Will your behavior encourage repeat visits from drug-seekers who back up the waiting room and put sick patients at higher risk of a bad outcome due to delays in care? After all, it has been frequently said, “If you feed the bears, the bears come back.”